Publications by authors named "Pavel Haninec"

27 Publications

  • Page 1 of 1

Long-Term Outcome After Midline Lumbar Fusion for the Treatment of Lumbar Spine Instability Due to Degenerative Disease.

World Neurosurg 2021 Jul 29. Epub 2021 Jul 29.

Department of Neurosurgery, Tomas Bata Regional Hospital, Zlin, Czech Republic. Electronic address:

Background: Midline lumbar fusion (MIDLF) is one promising new surgical technique that has been developed to minimize perioperative damage to the paravertebral stabilizing musculotendinous system. The aim of this study was to assess long-term clinical and radiological effects of MIDLF.

Methods: This prospective cohort study evaluated patients who underwent MIDLF for degenerative spinal instability. Clinical and radiological examinations were performed before and after surgery. Perioperative and postoperative complications were recorded. Follow-up was 2 years. P ≤ 0.05 was considered statistically significant.

Results: The study included 64 patients (mean age 58.9 ± 10.7 years; 41 women [64.1%]). The most frequent indication for MIDLF was degenerative spondylolisthesis grade I (28 cases [43.8%]); the prevalent spinal segment to be fused was L4-L5 (35 cases [54.7%]). Mean duration of surgery was 148.2 ± 28.9 minutes. Relief of low back pain and leg pain was significant and stable in the postoperative period as assessed by visual analog scale (P < 0.001). Of patients, 86.9% reported fair, good, or excellent outcomes in terms of pain relief based on MacNab score 2 years after surgery. Patients' level of function in activities of daily living improved significantly based on Oswestry Disability Index score: from 66.8 ± 9.8 before surgery to 33.9 ± 16.5 2 years after surgery (P < 0.001). X-rays and computed tomography at 12 months showed interbody fusion in 46 cases (73.4%), inconclusive results in 13 cases (20.3%), and no fusion in 4 cases (6.3%). No damage to neural or vascular structures and no failure of hardware or screw loosening were recorded.

Conclusions: MIDLF is a safe, efficient method for surgical treatment of lumbar spine instability. Its limited invasiveness contributes to better preservation of paravertebral muscles and enhanced postoperative spinal stability.
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http://dx.doi.org/10.1016/j.wneu.2021.07.108DOI Listing
July 2021

Trends and outcomes for non-elective neurosurgical procedures in Central Europe during the COVID-19 pandemic.

Sci Rep 2021 03 17;11(1):6171. Epub 2021 Mar 17.

Department of Neurosurgery, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic.

The world currently faces the novel severe acute respiratory syndrome coronavirus 2 pandemic. Little is known about the effects of a pandemic on non-elective neurosurgical practices, which have continued under modified conditions to reduce the spread of COVID-19. This knowledge might be critical for the ongoing second coronavirus wave and potential restrictions on health care. We aimed to determine the incidence and 30-day mortality rate of various non-elective neurosurgical procedures during the COVID-19 pandemic. A retrospective, multi-centre observational cohort study among neurosurgical centres within Austria, the Czech Republic, and Switzerland was performed. Incidence of neurosurgical emergencies and related 30-day mortality rates were determined for a period reflecting the peak pandemic of the first wave in all participating countries (i.e. March 16th-April 15th, 2020), and compared to the same period in prior years (2017, 2018, and 2019). A total of 4,752 emergency neurosurgical cases were reviewed over a 4-year period. In 2020, during the COVID-19 pandemic, there was a general decline in the incidence of non-elective neurosurgical cases, which was driven by a reduced number of traumatic brain injuries, spine conditions, and chronic subdural hematomas. Thirty-day mortality did not significantly increase overall or for any of the conditions examined during the peak of the pandemic. The neurosurgical community in these three European countries observed a decrease in the incidence of some neurosurgical emergencies with 30-day mortality rates comparable to previous years (2017-2019). Lower incidence of neurosurgical cases is likely related to restrictions placed on mobility within countries, but may also involve delayed patient presentation.
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http://dx.doi.org/10.1038/s41598-021-85526-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969942PMC
March 2021

Optic nerve sheath meningioma-findings in the contralateral optic nerve tract: A case report.

Mol Clin Oncol 2020 May 5;12(5):411-414. Epub 2020 Mar 5.

JL Clinic, Prague 15800, Czech Republic.

The aim of the present study was to observe visual pathway changes on the contralateral side in optic nerve sheath meningioma (ONSM). The authors present a case report of a 43-year-old patient with OfNSM on the right side. A complex ophthalmic examination was performed, including an assessment of visual functions, an electrophysiology examination and functional and structural MRI examinations. Visual acuity of the right eye after ONSM remained with no light perception, while that of the left side was normal. The visual field of the left eye was normal as was colour perception. An electrophysiology examination using a pattern electroretinogram revealed low amplitude values in the right eye. In the left eye, the finding was at the lower limit of normal results. The pattern visual evoked potential exhibited a bilateral lesion with a larger decrease in response after stimulation of the right eye. The structural MRI revealed intraorbital atrophy of the optic nerve on the right side throughout the whole course, which was accompanied by atrophy of the right half of the optic chiasm. Functional magnetic resonance imaging revealed zero activity after stimulation of the right eye and decreased activity in the visual centre after stimulation of the left eye. The present study demonstrated that unilateral damage to the optic nerve in ONSM is accompanied by significant changes on the contralateral side of the optic pathway.
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http://dx.doi.org/10.3892/mco.2020.2012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7087475PMC
May 2020

Lower subscapular nerve transfer for axillary nerve repair in upper brachial plexus palsy.

Acta Neurochir (Wien) 2020 01 12;162(1):135-139. Epub 2019 Nov 12.

Department of Neurosurgery, 3rd Faculty of Medicine, Charles University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.

Background: The potential to utilize the lower subscapular nerve for brachial plexus surgery has been suggested in many anatomical studies. However, we know of no studies in the literature describing the use of the lower subscapular nerve for axillary nerve reconstruction to date. This study aimed to examine the effectiveness of this nerve transfer in patients with upper brachial plexus palsy.

Methods: Of 1340 nerve reconstructions in 568 patients with brachial plexus injury performed by the senior author (P.H.), a subset of 18 patients underwent axillary nerve reconstruction using the lower subscapular nerve and constitutes the patient group for this study. The median age was 48 years, and the median time between trauma and surgery was 6 months. A concomitant radial nerve injury was found in 8 patients.

Results: Thirteen patients completed a minimum follow-up period of 24 months. Successful deltoid recovery was defined as (1) muscle strength MRC grade ≥ 3, (2) electromyographic signs of reinnervation, and (3) increase in deltoid muscle mass. Axillary nerve reconstruction was successful in 9 of 13 patients, which represents a success rate of 69.2%. No significant postoperative weakness of shoulder internal rotation or adduction was observed after transecting the lower subscapular nerve.

Conclusions: The lower subscapular nerve can be used as a safe and effective neurotization tool for upper brachial plexus injury, having a success rate of 69.2% for axillary nerve repair. Our technique presents a suitable alternative for patients with concomitant radial nerve injury.
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http://dx.doi.org/10.1007/s00701-019-04122-wDOI Listing
January 2020

Leaf Area Index Estimation Using Three Distinct Methods in Pure Deciduous Stands.

J Vis Exp 2019 08 29(150). Epub 2019 Aug 29.

Forestry and Game Management Research Institute, Research Station at Opočno.

Accurate estimations of leaf area index (LAI), defined as half of the total leaf surface area per unit of horizontal ground surface area, are crucial for describing the vegetation structure in the fields of ecology, forestry, and agriculture. Therefore, procedures of three commercially used methods (litter traps, needle technique, and a plant canopy analyzer) for performing LAI estimation were presented step-by-step. Specific methodological approaches were compared, and their current advantages, controversies, challenges, and future perspectives were discussed in this protocol. Litter traps are usually deemed as the reference level. Both the needle technique and the plant canopy analyzer (e.g., LAI-2000) frequently underestimate LAI values in comparison with the reference. The needle technique is easy to use in deciduous stands where the litter completely decomposes each year (e.g., oak and beech stands). However, calibration based on litter traps or direct destructive methods is necessary. The plant canopy analyzer is a commonly used device for performing LAI estimation in ecology, forestry, and agriculture, but is subject to potential error due to foliage clumping and the contribution of woody elements in the field of view (FOV) of the sensor. Eliminating these potential error sources was discussed. The plant canopy analyzer is a very suitable device for performing LAI estimations at the high spatial level, observing a seasonal LAI dynamic, and for long-term monitoring of LAI.
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http://dx.doi.org/10.3791/59757DOI Listing
August 2019

Traumatic optic neuropathy-a contralateral finding: A case report.

Exp Ther Med 2019 May 27;17(5):4244-4248. Epub 2019 Mar 27.

Department of Neurosurgery, 3rd Faculty of Medicine, Charles University in Prague, Teaching Hospital Královské Vinohrady, 10034 Prague, Czech Republic.

The present study demonstrates alterations of the contralateral side optic tract to an optic nerve traumatic lesion. Visual acuity of the right eye following Traumatic optic neuropathy (TON) remained at 0 following the injury. Electrophysiological examination using pattern electroretinogram revealed values reduced by 50% in the right eye compared with the left eye. Pattern visual-evoked potential evaluation indicated a bilateral lesion with a higher decrease following right eye stimulation. Magnetic resonance imaging revealed right optic nerve atrophy. Functional magnetic resonance imaging indicated decreased activity of the visual centre during left eye stimulation. The present study revealed contralateral visual tract alterations following unilateral injury, and hypothesize that the ganglion cells of the retina respond initially to glial activation. These changes are, in our view, followed by changes in the visual pathway.
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http://dx.doi.org/10.3892/etm.2019.7445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468911PMC
May 2019

Complete diagnostics and clinical approach for a female patient with unusual glioblastoma: A case study.

Mol Clin Oncol 2016 Jul 10;5(1):161-164. Epub 2016 May 10.

Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital, 128 08 Prague 2, Czech Republic.

The present study reports a case of a 44-year-old female patient with a large frontal lobe tumor who underwent surgery using a modern navigation system SonoWand that combines the advantages of a non-frame navigation system with intraoperative real-time ultrasound imaging. The right frontal lobe tumor consisted of two morphologically different sections. A diffuse astrocytoma grade II and a glioblastoma grade IV were identified. These tumors were relatively substantially separated. A 17 p deletion, including , was detected in a diffuse astrocytoma but not in a glioblastoma. and amplifications were detected only in a glioblastoma. Detection of these amplifications is typical for primary glioblastomas. These findings support our assumption of two independent tumors. The , and gene mutations were also detected in a glioblastoma. Such an accumulation of molecular mutations is rare in one tumor. Following oncological treatment the patient was cared for in the oncological center and survived for 15 months after the surgery without any signs of a disease. This is an unusual case, and to the best of our knowledge, is not frequently published in literature.
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http://dx.doi.org/10.3892/mco.2016.891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906621PMC
July 2016

Preserved cutaneous silent period in cervical root avulsion.

J Spinal Cord Med 2017 03 27;40(2):175-180. Epub 2015 Aug 27.

a Department of Neurology , Third Faculty of Medicine, Charles University , Prague , Czech Republic.

Objective: Brachial plexus injuries are usually severe and involve the entire brachial plexus, sometimes occurring with root avulsions. Imaging and electrodiagnostic studies are an essential part of the lesion evaluation; however, the results sometimes show a discrepancy. The cutaneous silent period (SP) is a spinal inhibitory reflex mediated by small-diameter A-delta nociceptive fibers. The aim of the study was to determine if cutaneous SP testing may serve as a useful aid in evaluation of brachial plexus injury and/or in the diagnosis of root avulsion.

Methods: In 19 patients with traumatic brachial plexus injury (15 males, age 18-62 years) we performed a clinical examination, CT myelography and neurophysiological testing. A needle EMG was obtained from muscles supplied by C5-T1 myotomes. Cutaneous SP was recorded after painful stimuli were delivered to the thumb (C6 dermatome), middle (C7) and little (C8) fingers while subjects maintained voluntary contraction of intrinsic hand muscles.

Results: Electrodiagnostic and imaging studies confirmed root avulsion (partial or total) maximally involving C5, C6 roots in 12 patients, whereas only in 4 of them the cutaneous SP was partially absent. In the remaining subjects, the cutaneous SP was preserved.

Conclusion: In brachial plexopathy even with plurisegmental root avulsion, the cutaneous SP was mostly preserved. This method cannot be recommended as a reliable test for diagnosis of single root avulsion; however, it can provide a quick physiological confirmation of functional afferent A-delta fibers through damaged roots and/or trunks. The clinicians may add this test to the diagnosis of spinal cord dysfunction.
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http://dx.doi.org/10.1179/2045772315Y.0000000053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430474PMC
March 2017

Results of nerve reconstructions in treatment of obstetrical brachial plexus injuries.

Acta Neurochir (Wien) 2015 Apr 24;157(4):673-80. Epub 2015 Jan 24.

Department of Neurosurgery, 3rd Faculty of Medicine, Charles University, Faculty Hospital Královské Vinohrady, Prague, Czech Republic.

Background: The aim of this study was to evaluate the results achieved using various surgical techniques in patients with partial and total obstetrical brachial plexus palsy.

Methods: From 2000 to 2013, 33 patients with obstetrical brachial plexus injury underwent surgery. Twenty had follow-up periods greater than 24 months and met the criteria for inclusion in the study. All patients were evaluated using the Active Movement Scale.

Results: The outcomes of different nerve reconstructive procedures including nerve transfers, nerve grafting after neuroma resection and end-to-side neurorrhaphy are presented. The overall success rate in upper plexus birth injury was 80 % in shoulder abduction, 50 % in external rotation and 81.8 % in elbow flexion with median follow-ups of 36 months. Success rate in complete paralysis was 87 % in finger and thumb flexion, 87 % in shoulder abduction and 75 % in elbow flexion; the median follow-up was 46 months. Useful reanimation of the hand was obtained in both patients who underwent end-to-side neurotization.

Conclusion: Improved function can be obtained in infants with obstetrical brachial plexus injury with early surgical reconstruction.
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http://dx.doi.org/10.1007/s00701-015-2347-2DOI Listing
April 2015

Usefulness of screening tools in the evaluation of long-term effectiveness of DREZ lesioning in the treatment of neuropathic pain after brachial plexus injury.

BMC Neurol 2014 Dec 9;14:225. Epub 2014 Dec 9.

Department of Anesthesiology and Critical Care Medicine, Third Faculty of Medicine, Charles University, Hospital Kralovske Vinohrady, Prague, Czech Republic.

Background: Despite high success rate of DREZ lesioning in the treatment of intractable central pain, there is still a significant incidence of patients without satisfactory post-operative effect. The aim of the study was to evaluate the long-term effect of DREZ lesioning using both a subjective assessment using a visual analog scale (VAS) to quantify residual pain and an assessment using the screening tool (painDETECT Questionnaire, PD-Q).

Methods: DREZ lesioning was performed in 52 patients from a total 441 cases with brachial plexus injury (11.8%) during a 17-year period (1995-2011). The effect of surgery was retrospectively assessed in 48 patients.

Results: A decrease in pre-operative pain by more than 75% (Group I) was achieved in 70.8% of patients and another 20.8% reported significant improvement (Group II). The surgery was unsucessful in 8.4% (Group III). We found a significant correlation between 'improvement' groups from both methods of assessments. Patients from Group I usually complained of residual nociceptive pain according to PD-Q, patients from Group II typically had pain of unclear origin, and all cases those in Group III suffered from neuropathic pain, Cramer's V = .66, P < .001. Overall, 66.7% of patients had resolved neuropathic pain, 20.8% patients had more serious complaints and may also suffer from residual neuropathic pain, while 12.5% had unresolved neuropathic pain.

Conclusion: DREZ lesioning is a safe and effective method with success rates of about 90%. PD-Q scores correspond to subjective satisfaction with the surgery and it seems to be a suitable screening tool for finding patients with residual neuropathic pain after surgery.
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http://dx.doi.org/10.1186/s12883-014-0225-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264322PMC
December 2014

End-to-side neurorrhaphy in brachial plexus reconstruction.

J Neurosurg 2013 Sep 12;119(3):689-94. Epub 2013 Jul 12.

Third Faculty of Medicine, Charles University, Department of Neurosurgery, Hospital Kralovske Vinohrady, Prague, Czech Republic.

Object: Although a number of theoretical and experimental studies dealing with end-to-side neurorrhaphy (ETSN) have been published to date, there is still a considerable lack of clinical trials investigating this technique. Here, the authors describe their experience with ETSN in axillary and musculocutaneous nerve reconstruction in patients with brachial plexus palsy.

Methods: From 1999 to 2007, out of 791 reconstructed nerves in 441 patients treated for brachial plexus injury, the authors performed 21 axillary and 2 musculocutaneous nerve sutures onto the median, ulnar, or radial nerves. This technique was only performed in patients whose donor nerves, such as the thoracodorsal and medial pectoral nerves, which the authors generally use for repair of axillary and musculocutaneous nerves, respectively, were not available. In all patients, a perineurial suture was carried out after the creation of a perineurial window.

Results: The overall success rate of the ETSN was 43.5%. Reinnervation of the deltoid muscle with axillary nerve suture was successful in 47.6% of the patients, but reinnervation of the biceps muscle was unsuccessful in the 2 patients undergoing musculocutaneous nerve repair.

Conclusions: The authors conclude that ETSN should be performed in axillary nerve reconstruction but only when commonly used donor nerves are not available.
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http://dx.doi.org/10.3171/2013.6.JNS122211DOI Listing
September 2013

Serious axillary nerve injury caused by subscapular artery compression resulting from use of backpacks.

J Neurol Surg A Cent Eur Neurosurg 2013 Dec 21;74 Suppl 1:e225-8. Epub 2013 May 21.

Department of Neurosurgery, Charles University, Third Faculty of Medicine, Prague, Czech Republic.

A palsy of the brachial plexus elements caused by carrying a heavy backpack is a very rare injury usually occurring in soldiers or hikers, and recovery is usually spontaneous. We describe here the case of male civilian presenting with an isolated serious axillary nerve palsy associated with chronic backpack use. During the surgery, a dumbbell-shaped neuroma-in-continuity was found which was caused by direct pressure from the subscapular artery. After resection of the neuroma, a nerve graft from the sural nerve was used to reconstruct the nerve. Reinnervation was successful and the patient was able to abduct his arm to its full range, with full muscle strength, within 24 months.
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http://dx.doi.org/10.1055/s-0033-1343987DOI Listing
December 2013

A Comparison of collateral sprouting of sensory and motor axons after end-to-side neurorrhaphy with and without the perineurial window.

Plast Reconstr Surg 2012 Sep;130(3):609-614

Prague and Brno, Czech Republic From the Department of Neurosurgery, 3rd Faculty of Medicine, Charles University, and the Department of Anatomy, Division of Neuroanatomy, Faculty of Medicine, and Central European Institute of Technology, Masaryk University.

Background: Many experimental studies have confirmed collateral sprouting of axons after end-to-side neurorrhaphy and its possible clinical application. There is still controversy about how the surgical method should be carried out. The aim of the present study was to quantitatively evaluate collateral sprouting of motor and sensory axons after end-to-side neurorrhaphy with and without the perineurial window.

Methods: End-to-side neurorrhaphy of the distal stump of transected musculocutaneous nerve with intact ulnar nerve with or without a perineurial window was performed in a rat model. Collateral sprouts were quantitatively evaluated by counting of motor and sensory neurons following their retrograde labeling by Fluoro-Ruby and Fluoro-Emerald applied to the ulnar and musculocutaneous nerves, respectively.

Results: Our results show that significantly more motor and sensory axons sent their collateral branches into the recipient nerve in the group with a perineurial window. Some axons were injured during preparation of the perineurial window; the injured axons reinnervated directly into the recipient nerve to contribute to results of functional reinnervation.

Conclusion: The authors conclude that it is necessary to create a perineurial window when using end-to-side neurorrhaphy in clinical practice, especially in brachial plexus reconstruction.
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http://dx.doi.org/10.1097/PRS.0b013e31825dc20aDOI Listing
September 2012

The influence of seatbelts on the types of operated brachial plexus lesions caused by car accidents.

J Hand Surg Am 2012 Aug 3;37(8):1657-9. Epub 2012 Jul 3.

Department of Neurosurgery, 3rd Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.

Purpose: To determine whether there is a relationship between seatbelt use and type of brachial plexus injury seen in automobile accidents. Knowledge of such a relationship may help guide the surgical management of these patients.

Methods: We retrospectively evaluated 43 surgical patients with brachial plexus palsy caused by car accidents. We recorded sex, age, and type of injury for each case. We also obtained data regarding the patients' position in the car at the time of the accident and whether they were wearing a seatbelt.

Results: We obtained data on 39 men and 4 women. Of the seatbelted patients, 24 (100%) had upper plexus palsy on the side where the seatbelt crossed the shoulder. Of those who were not wearing seatbelts, 17 (86%) had complete plexus injuries. We also found 1 upper and 1 lower plexus injury in the unbelted group.

Conclusions: We found a relationship between the type of brachial plexus injury sustained by the accident victim and the use and position of the seatbelt. Complete plexus injuries were more common in those who were not wearing seatbelts. We saw upper plexus injuries for those wearing seatbelts. Information about seatbelt use may be useful in clinical practice. When treating an unbelted car accident victim with a brachial plexus injury, it is reasonable to anticipate a more serious form of the injury.

Type Of Study/level Of Evidence: Prognostic IV.
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http://dx.doi.org/10.1016/j.jhsa.2012.05.019DOI Listing
August 2012

Axillary nerve repair by fascicle transfer from the ulnar or median nerve in upper brachial plexus palsy.

J Neurosurg 2012 Sep 29;117(3):610-4. Epub 2012 Jun 29.

Department of Neurosurgery, 3rd Faculty of Medicine, Charles University, Hospital Kralovske Vinohrady, Prague, Czech Republic.

Object: Nerve repair using motor fascicles of a different nerve was first described for the repair of elbow flexion (Oberlin technique). In this paper, the authors describe their experience with a similar method for axillary nerve reconstruction in cases of upper brachial plexus palsy.

Methods: Of 791 nerve reconstructions performed by the senior author (P.H.) between 1993 and 2011 in 441 patients with brachial plexus injury, 14 involved axillary nerve repair by fascicle transfer from the ulnar or median nerve. All 14 of these procedures were performed between 2007 and 2010. This technique was used only when there was a deficit of the thoracodorsal or long thoracic nerve, which are normally used as donors.

Results: Nine patients were followed up for 24 months or longer. Good recovery of deltoid muscle strength was seen in 7 (77.8%) of these 9 patients, and in 4 patients with less follow-up (14-23 months), for an overall success rate of 78.6%. The procedure was unsuccessful in 2 of the 9 patients with at least 24 months of follow-up. The first showed no signs of reinnervation of the axillary nerve by either clinical or electromyographic evaluation in 26 months of follow-up, and the second had Medical Research Council (MRC) Grade 2 strength in the deltoid muscle 36 months after the operation. The last of the group of 14 patients has had 12 months of follow-up and is showing progressive improvement of deltoid muscle function (MRC Grade 2).

Conclusions: The authors conclude that fascicle transfer from the ulnar or median nerve onto the axillary nerve is a safe and effective method for reconstruction of the axillary nerve in patients with upper brachial plexus injury.
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http://dx.doi.org/10.3171/2012.5.JNS111572DOI Listing
September 2012

Enhancement of musculocutaneous nerve reinnervation after vascular endothelial growth factor (VEGF) gene therapy.

BMC Neurosci 2012 Jun 6;13:57. Epub 2012 Jun 6.

Department of Neurosurgery, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.

Background: Vascular endothelial growth factor (VEGF) is not only a potent angiogenic factor but it also promotes axonal outgrowth and proliferation of Schwann cells. The aim of the present study was to quantitatively assess reinnervation of musculocutaneous nerve (MCN) stumps using motor and primary sensory neurons after plasmid phVEGF transfection and end-to-end (ETE) or end-to-side (ETS) neurorrhaphy. The distal stump of rat transected MCN, was transfected with plasmid phVEGF, plasmid alone or treated with vehiculum and reinnervated following ETE or ETS neurorrhaphy for 2 months. The number of motor and dorsal root ganglia neurons reinnervating the MCN stump was estimated following their retrograde labeling with Fluoro-Ruby and Fluoro-Emerald. Reinnervation of the MCN stumps was assessed based on density, diameter and myelin sheath thickness of regenerated axons, grooming test and the wet weight index of the biceps brachii muscles.

Results: Immunohistochemical detection under the same conditions revealed increased VEGF in the Schwann cells of the MCN stumps transfected with the plasmid phVEGF, as opposed to control stumps transfected with only the plasmid or treated with vehiculum. The MCN stumps transfected with the plasmid phVEGF were reinnervated by moderately higher numbers of motor and sensory neurons after ETE neurorrhaphy compared with control stumps. However, morphometric quality of myelinated axons, grooming test and the wet weight index were significantly better in the MCN plasmid phVEGF transfected stumps. The ETS neurorrhaphy of the MCN plasmid phVEGF transfected stumps in comparison with control stumps resulted in significant elevation of motor and sensory neurons that reinnervated the MCN. Especially noteworthy was the increased numbers of neurons that sent out collateral sprouts into the MCN stumps. Similarly to ETE neurorrhaphy, phVEGF transfection resulted in significantly higher morphometric quality of myelinated axons, behavioral test and the wet weight index of the biceps brachii muscles.

Conclusion: Our results showed that plasmid phVEGF transfection of MCN stumps could induce an increase in VEGF protein in Schwann cells, which resulted in higher quality axon reinnervation after both ETE and ETS neurorrhaphy. This was also associated with a better wet weight biceps brachii muscle index and functional tests than in control rats.
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http://dx.doi.org/10.1186/1471-2202-13-57DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3441459PMC
June 2012

Injuries associated with serious brachial plexus involvement in polytrauma among patients requiring surgical repair.

Injury 2014 Jan 1;45(1):223-6. Epub 2012 Jun 1.

3(rd) Faculty of Medicine, Charles University, Department of Neurosurgery, Faculty Hospital Kralovske Vinohrady, Srobarova 50, 100 34 Prague, Czech Republic. Electronic address:

Background: Brachial plexus injury occurs in up to 5% of polytrauma cases involving motorcycle crashes and in approximately 4% of severe winter sports injuries. One of the conditions for the success of operative therapy is early detection, ideally within three months of injury. The aim of this study was to evaluate associated injuries in patients with severe brachial plexus injury and determine whether there is a characteristic concomitant injury (or injuries), the presence of which, in the polytrauma, could act as a marker for nerve structures involvement and whether there are differences in severity of polytrauma accompanying specific types of brachial plexus injury.

Methods: We evaluated retrospectively 84 surgical patients from our department, from 2008 to 2011, that had undergone brachial plexus reconstruction. For all, an injury severity scale (ISS) score and all major associated injuries were determined.

Results: 72% of patients had an upper, 26% had a complete and only 2% had a lower brachial plexus palsy. The main cause was motorcycle crashes (60%) followed by car crashes (15%). The average ISS was 35.2 (SD=23.3), although, values were significantly higher in cases involving a coma (59.3, SD=11.0). The lower and complete plexus injuries were significantly associated with coma and fractures of the shoulder girdle and injuries of lower limbs, thoracic organs and head. Upper plexus injuries were associated with somewhat less severe injuries of the upper and lower extremities and less severe injuries of the spine.

Conclusion: Serious brachial plexus injury is usually accompanied by other severe injuries. It occurs in high-energy trauma and it can be stated that patients involved in motorcycle and car crashes with multiple fractures of the shoulder girdle are at high risk of nerve trauma. This is especially true for patients in a primary coma. Lower and complete brachial plexus injuries are associated with higher injury severity scale.
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http://dx.doi.org/10.1016/j.injury.2012.05.013DOI Listing
January 2014

The end-to-side neurorrhaphy in axillary nerve reconstruction in patients with brachial plexus palsy.

Plast Reconstr Surg 2012 May;129(5):882e-883e

Third Faculty of Medicine, Charles University, Department of Neurosurgery, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.

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http://dx.doi.org/10.1097/PRS.0b013e31824b2a5bDOI Listing
May 2012

Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents.

Acta Neurochir (Wien) 2012 Jul;154(7):1293-7

Third Faculty of Medicine, Department of Neurosurgery, Hospital Kralovske Vinohrady, Charles University, Srobarova 50, 100 34, Prague, Czech Republic.

Background: Brachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents.

Methods: A total of 441 brachial plexus reconstruction patients from our department were evaluated retrospectively(1993 to 2011). Sex, age, neurological status, and the type and cause of injury were recorded for each case. Patients with BPI caused by a traffic accident were assessed in detail.

Results: Traffic accidents were the cause of brachial plexus injury in most cases (80.7%). The most common type of injury was avulsion of upper root(s) (45.7%) followed by rupture (28.2%), complete avulsion (16.9%) and avulsion of lower root(s) (9.2%). Of the patients, 73.9% had an upper,22.7% had a complete and only 3.4% had a lower brachial plexus palsy. The main cause was motorcycle accidents(63.2%) followed by car accidents (23.5%), bicycle accidents(10.7%) and pedestrian collisions (3.1%) (p<0.001).Patients involved in car accidents had a higher percentage of lower avulsion (22.7%) and a lower percentage of upper avulsion (29.3%), whereas cyclists had a higher percentage of upper avulsion (68.6%) based on the data from the entire group of patients (p<0.001). Lower plexus palsy was significantly increased in patients after car accidents (9.3%,p<0.05). In the two main groups (car and motorcycle accidents),significantly more upper and fewer lower palsies were present. In the bicycle accident group, upper palsy was the most common (89%).

Conclusion: Study results indicate that the most common injury was an upper plexus palsy. It was characteristic of bicycle accidents, and significantly more common in car and motorcycle accidents. The results also indicate that it is important to consider the potential of a brachial plexus injury after serious traffic accidents and to examine both upper extremities in detail even if some motor function is preserved.
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http://dx.doi.org/10.1007/s00701-012-1291-7DOI Listing
July 2012

Ciliary neurotrophic factor promotes motor reinnervation of the musculocutaneous nerve in an experimental model of end-to-side neurorrhaphy.

BMC Neurosci 2011 Jun 22;12:58. Epub 2011 Jun 22.

Department of Anatomy, Division of Neuroanatomy, Faculty of Medicine, and Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 3, CZ-625 00 Brno, Czech Republic.

Background: It is difficult to repair nerve if proximal stump is unavailable or autogenous nerve grafts are insufficient for reconstructing extensive nerve damage. Therefore, alternative methods have been developed, including lateral anastomosis based on axons' ability to send out collateral sprouts into denervated nerve. The different capacity of a sensory or motor axon to send a sprout is controversial and may be controlled by cytokines and/or neurotrophic factors like ciliary neurotrophic factor (CNTF). The aim of the present study was to quantitatively assess collateral sprouts sent out by intact motor and sensory axons in the end-to-side neurorrhaphy model following intrathecal administration of CNTF in comparison with phosphate buffered saline (vehiculum) and Cerebrolysin. The distal stump of rat transected musculocutaneous nerve (MCN) was attached in an end-to-side fashion with ulnar nerve. CNTF, Cerebrolysin and vehiculum were administered intrathecally for 2 weeks, and all animals were allowed to survive for 2 months from operation. Numbers of spinal motor and dorsal root ganglia neurons were estimated following their retrograde labeling by Fluoro-Ruby and Fluoro-Emerald applied to ulnar and musculocutaneous nerve, respectively. Reinnervation of biceps brachii muscles was assessed by electromyography, behavioral test, and diameter and myelin sheath thickness of regenerated axons.

Results: Vehiculum or Cerebrolysin administration resulted in significantly higher numbers of myelinated axons regenerated into the MCN stumps compared with CNTF treatment. By contrast, the mean diameter of the myelinated axons and their myelin sheath thickness in the cases of Cerebrolysin- or CNTF-treated animals were larger than were those for rats treated with vehiculum. CNTF treatment significantly increased the percentage of motoneurons contributing to reinnervation of the MCN stumps (to 17.1%) when compared with vehiculum or Cerebrolysin treatments (at 9.9 or 9.6%, respectively). Reduced numbers of myelinated axons and simultaneously increased numbers of motoneurons contributing to reinnervation of the MCN improved functional reinnervation of the biceps brachii muscle after CNTF treatment.

Conclusion: The present experimental study confirms end-to-side neurorrhaphy as an alternative method for reconstructing severed peripheral nerves. CNTF promotes motor reinnervation of the MCN stump after its end-to-side neurorrhaphy with ulnar nerve and improves functional recovery of the biceps brachii muscle.
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http://dx.doi.org/10.1186/1471-2202-12-58DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224149PMC
June 2011

Decompressive surgery for malignant supratentorial infarction remains underutilized after guideline publication.

J Neurol 2011 Sep 24;258(9):1689-94. Epub 2011 Mar 24.

Department of Neurology, Faculty Hospital Ostrava, Tr. 17. Listopadu 1790, 708 52 Ostrava, Czech Republic.

Decompressive surgery <48 h from stroke onset reduces the prevalence of mortality and morbidity from malignant supratentorial infarction. We investigated if utilization of decompressive surgery changed in the Czech Republic (CZ) after the release of new guidelines regarding treatment of malignant brain infarction. The volume of decompressive surgery in 2009 in all centers in the CZ was assessed using the same methodology as in 2006. All neurosurgery departments in the CZ were asked to complete a questionnaire and asked to identify all cases of decompressive surgery for malignant brain infarction through a combination of discharge codes for "brain infarction" and "decompressive surgery" from electronic hospital charts. Data for 56 patients were obtained from 15 of the 16 neurosurgery departments in the CZ. The average age was 53 ± 13; number of males 20; median time to surgery was 48 h (range 24-62); median NIHSS score was 25 (IQR, 20-30); median infarct volume was 300 cm(3) [interquartile (IQR, 250-350)]; mean shift on CT was 10.6 ± 3.6 mm and size of hemicraniectomy was 125 cm(2) (IQR, 110-154). A favorable outcome was achieved in 45% of the patients. The number of procedures increased from 39 in 2,006 to 2,056 in 2009. Based on data from one stroke center, 10% suffered from malignant supratentorial infarction and 2.3% met the criteria for decompressive surgery. In 2009, as compared to 2006, the volume of decompressive surgery carried out moderately increased. However, procedures remained underutilized because only ~10% of those who needed decompressive surgery underwent surgery.
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http://dx.doi.org/10.1007/s00415-011-6003-3DOI Listing
September 2011

Dymanics of matrix-metalloproteinase 9 after brain trauma--results of a pilot study.

Acta Neurochir Suppl 2008 ;102:373-6

Department of Anesthesiology and Critical Care Medicine, Charles University in Prague, Third Faculty of Medicine, Ruska 87, 100 34 Prague, 10, Czech Republic.

Background: Secondary brain injury contributes to poor outcome for patients sustaining brain trauma. Matrix metalloproteinase-9 (MMP-9) is a potential marker, as well as effector of secondary brain injury. This enzyme degrades components of extracellular matrix, and thus it can contribute to blood-brain barrier disruption.

Methods: We studied dynamics of MMP-9 in jugular venous blood of 15 patients sustaining either an isolated head injury or a head injury as a part of major trauma, and requiring intensive care (Glasgow Coma Scale <8 at the time of admission). Blood samples were taken at the 1st, 3rd and 5th day, levels of MMP-9 in plasma were assessed using ELISA. Outcome quality was assessed at the time of discharge from our hospital.

Findings: Our results show an increase of MMP-9 levels on the 1st day after the brain trauma, followed by a drop on the 3rd day and a rise on day 5. This biphasic time-course was observed in all patients, but no statistically significant differences between each group (major trauma vs. isolated brain trauma, good outcome vs. poor outcome) were found.

Conclusions: Initially increased MMP-9 levels in the 1st posttraumatic day is probably related to transient blood-brain barrier dysruption. The decrease of MMP-9 levels observed on the 3rd day can be explained by restoration of blood-brain barrier integrity and its reduced permeability. The second rise of MMP-9 levels observed in the 5th day probably indicates a developing secondary brain injury during which MMP-9 is produced in the brain as a part of an inflammatory response.

Results: of our study suggest that MMP-9 could play an important role in pathogenesis of secondary brain injury.
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http://dx.doi.org/10.1007/978-3-211-85578-2_71DOI Listing
June 2009

Direct repair (nerve grafting), neurotization, and end-to-side neurorrhaphy in the treatment of brachial plexus injury.

J Neurosurg 2007 Mar;106(3):391-9

Department of Neurosurgery, Third Faculty of Medicine, Charles University, Prague, Czech Republic.

Object: The authors present the long-term results of nerve grafting and neurotization procedures in their group of patients with brachial plexus injuries and compare the results of "classic" methods of nerve repair with those of end-to-side neurorrhaphy.

Methods: Between 1994 and 2006, direct repair (nerve grafting), neurotization, and end-to-side neurorrhaphy were performed in 168 patients, 95 of whom were followed up for at least 2 years after surgery. Successful results were achieved in 79% of cases after direct repair and in 56% of cases after end-to-end neurotization. The results of neurotization depended on the type of the donor nerve used. In patients who underwent neurotization of the axillary and the musculocutaneous nerves, the use of intraplexal nerves (motor branches of the brachial plexus) as donors of motor fibers was associated with a significantly higher success rate than the use of extraplexal nerves (81% compared with 49%, respectively, p = 0.003). Because of poor functional results of axillary nerve neurotization using extraplexal nerves (success rate 47.4%), the authors used end-to-side neurorrhaphy in 14 cases of incomplete avulsion. The success rate for end-to-side neurorrhaphy using the axillary nerve as a recipient was 64.3%, similar to that for neurotization using intraplexal nerves (68.4%) and better than that achieved using extraplexal nerves (47.4%, p = 0.19).

Conclusions: End-to-side neurorrhaphy offers an advantage over classic neurotization in not requiring sacrifice of any of the surrounding nerves or the fascicles of the ulnar nerve. Typical synkinesis of muscle contraction innervated by the recipient nerve with contraction of muscles innervated by the donor was observed in patients after end-to-side neurorrhaphy.
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http://dx.doi.org/10.3171/jns.2007.106.3.391DOI Listing
March 2007

Quantitative assessment of the ability of collateral sprouting of the motor and primary sensory neurons after the end-to-side neurorrhaphy of the rat musculocutaneous nerve with the ulnar nerve.

Ann Anat 2006 Jul;188(4):337-44

Department of Neurosurgery, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.

In view of the Lack of theoretical information, end-to-side neurorrhaphy is a frequent object of experimental interest. End-to-side neurorrhaphy is based on collateral sprouting of an intact axon. The quantitative assessment of collateral sprouts sent by an intact motor and sensory axon was the goal of the present study. End-to-side neurorrhaphy of the distal stump of transected musculocutaneous nerve (MCN) with intact ulnar nerve (UN) was performed in a rat model. Collateral sprouts were quantitatively evaluated by counting of motoneurons and DRG neurons following their retrograde labeling by Fluoro-Ruby and Fluoro-Emerald applied to the UN and MCN, respectively. The results suggest a comparable capacity of both intact sensory and motor axons to send collateral sprouts into a denervated nerve stump. The ratio of sensory/motor neurons, the axons of which reinnervated distal MCN stumps, was very similar to that of intact UN (6.500 and 6.747, respectively), but different from intact MCN (5.029). This suggests that the pruning process occurred to balance the collateral sprouts at a ratio of sensory/motor neurons for the donor UN, but not according to the number of sensory and motor bands of Bungner available in the distal stump of the MCN. The present experimental study confirms end-to-side neurorrhaphy as a suitable method of nerve reconstruction.
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http://dx.doi.org/10.1016/j.aanat.2006.01.017DOI Listing
July 2006

Dorsal root entry zone (DREZ) localization using direct spinal cord stimulation can improve results of the DREZ thermocoagulation procedure for intractable pain relief.

Pain 2005 Jul;116(1-2):159-63

Department of Neurosurgery, 3rd Faculty of Medicine, Faculty Hospital Královské Vinohrady, Charles University, Prague, Czech Republic.

The dorsal root entry zone (DREZ) thermocoagulation for intractable pain after brachial plexus avulsion was performed in 21 patients. Good results in pain relief (relief of more than 75% of preoperative pain) were achieved in 62% of patients, whereby fair results (relief of 25-75% of preoperative pain) in 38% of patients. There was no patient with poor result (relief of less than 25% of preoperative pain). Complication rate was 14%. The whole patient population was subdivided into two groups (Group 1 and Group 2). Direct spinal cord bipolar stimulation and registration with the goal to localize DREZ was performed in the Group 2 consisting of 12 patients (n=12). The point on the spinal cord surface where no response after stimulus of low intensity was obtained was the site (the posterolateral sulcus) we identified as the most suitable point for the placement of radiofrequency thermocoagulation electrode. Comparing with the Group 1 consisting of nine patients (n=9), where the localization of DREZ by evoked potentials was not performed, significantly better effect of pain relief was recorded (P<0.05, odds ratio 10). There was no statistically significant difference (P>0.7) in complication rate in Group 1 and Group 2. Described electrophysiological technique is very helpful in identifying of DREZ and, in combination with microsurgical technique, can create DREZ thermocoagulation more effective.
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http://dx.doi.org/10.1016/j.pain.2005.03.015DOI Listing
July 2005

Rescue of rat spinal motoneurons from avulsion-induced cell death by intrathecal administration of IGF-I and Cerebrolysin.

Ann Anat 2003 Jun;185(3):233-8

Division of Neurosurgery, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.

Ventral root avulsion results in the loss of motoneurons in the corresponding spinal cord segment. In the present experiments we have tested effects of insulin-like growth factor-I (IGF-I) and Cerebrolysin on survival of avulsed motoneurons after their chronic intrathecal administration in the adult rats. We have found that avulsion of the C5 ventral roots results in significant loss of motoneurons in the same spinal cord segment due mainly to apoptosis. In comparison to the untreated control rats, the amount of motoneuron survival in avulsed ventral horn was significantly higher after 4 weeks intrathecal administration of IGF-I or Cerebrolysin. No significant differences were observed between effects of IGF-I and Cerebrolysin in our experimental model. The results suggest that both IGF-I and Cerebrolysin can reduce avulsion-induced loss of adult rat motoneurons.
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http://dx.doi.org/10.1016/S0940-9602(03)80030-4DOI Listing
June 2003

Craniopharyngioma: a case report and comparative galectin histochemical analysis.

Histochem J 2002 Mar-Apr;34(3-4):117-22

1st Faculty of Medicine, Institute of Anatomy, Charles University, Prague, Czech Republic.

Craniopharyngioma is a rare benign tumour originating from Rathke's pouch. This paper reports a tumour case studied with a set of markers defining protein-carbohydrate recognition. Expression of endogenous lectins and their reactive glycoligands is under differentiation-dependent control in many cell types. These parameters can be related to the degree of cell differentiation in tumours. Therefore, the expression patterns of endogenous lectins, namely galectins-1, -3, and -7, in the craniopharyngioma case were determined. Galectins-1 and -3 were also used to reveal glycoconjugates in cells and extracellular matrices, an approach that has heretofore relied largely on plant lectins. The staining pattern of craniopharyngioma is compared with that of two other types of ectodermally derived tumours, namely basal and squamous cell carcinomas. Clusters of polygonal and flattened cells with morphological characteristics of differentiated cells in the craniopharyngioma and the majority of poorly differentiated cells in squamous cell carcinomas were reactive with galectin-3. No binding of this probe was observed in cells of basal cell carcinomas and the majority of craniopharyngioma cells. In view of the lack of accessible binding in the basal layer of normal squamous epithelia where proliferative cells (including stem cells) are located, galectin-3 binding could be used to distinguish basal from suprabasal cells of squamous epithelial cells.
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http://dx.doi.org/10.1023/a:1020934329211DOI Listing
May 2003
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